Association between high-density lipoprotein cholesterol to apolipoprotein A ratio and diabetic retinopathy: A cross-sectional study

Abstract

AimsOur study is aimed to investigate the relationship between high-density lipoprotein cholesterol to apolipoprotein A ratio (HDL-C/ApoA) and diabetic retinopathy (DR) in subjects with type 2 diabetes mellitus (T2DM). MethodsWe retrospect the consecutive medical files of 1058 subjects with T2DM and recorded their clinical information and laboratory findings. Subjects with T2DM were divided into DR group (n = 522) and non-DR group (n = 536). We compared the lipids values of the two groups. Meanwhile we also observed the prevalence of DR at different HDL-C/ApoA levels. Binary logistic regression was used to correct confounding factors. Smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between HDL/ApoA and DR. ResultsHDL-C/ApoA value of DR group was significantly higher than non-DR group (0.88 ± 0.17 vs 0.84 ± 0.13, P < 0.05). The prevalence of DR significantly increased as HDL-C/ApoA level increased. There was association between HDL/ApoA levels and DR in the adjusted models (OR 1.55, 95%CI 0.60 to 4.02). After full adjustments for other relevant clinical covariates, patients with HDL/ApoA values in quartile 3 (Q3) had 1.50 times (95 % CI 1.00 to 2.17) and in Q4 had 2.39 times (95%CI 1.65 to 3.47) as high as the risk of DR compared with patients in Q1. HDL/ApoA showed a non-linear relationship with DR, with an inflection point value of 0.759. When HDL/ApoA>0.759, HDL/ApoA was significantly positively associated with DR (HR = 26.508, 95 % CI 7.623–92.174; P < 0.0001). Compared to patients with age < 60, HDL/ApoA was obviously associated with DR when age ≥ 60 (OR = 38.05, 95 % CI 8.06–179.69; P < 0.001). ConclusionsHDL-C/ApoA was found to be associated with the incidence of DR in patients with T2DM. After adjusting potential related factors HDL-C/ApoA OR value was 1.55 (95%CI 0.60 to 4.02). A non-linear association between HDL/ApoA and DR was observed in T2DM. Subgroup analysis showed that age could alter the relationship between HDL/ApoA and DR.